Continued disparity exists among IBD diagnoses
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Crohn’s disease and ulcerative colitis disproportionately affected non-Hispanic white patients, according to research presented at Digestive Disease Week.
“The demographics of the United States are rapidly changing; by 2044, non-Hispanic whites will no longer comprise a majority of the population,” Edward Barnes, MD, MPH, University of North Carolina at Chapel Hill, said. “Historically, IBD has been considered to be a disease of non-Hispanic whites, the current burden of CD and UC among minority populations is largely unknown. ... Improved understanding of the epidemiology of CD and UC in the U.S., particularly among minority populations, has important implications; it is critical to understand the demographics to provide a foundation for future clinical and research efforts.”
To investigate the relative prevalence of IBD across racial and ethnic groups, researchers evaluated 39,864,077 patients with a diagnosis of either CD or UC from electronic health records. They further stratified analyses by pediatric patients vs. adult patients.
According to health records, pediatric patients and adult patients with CD and UC were more likely to be white and non-Hispanic while Black or African American pediatric patients and adult patients were significantly less likely to have a diagnosis of CD (OR = 0.41; 95% CI, 0.39-0.43; OR = 0.53; 95% CI, 0.52-0.54, respectively) or UC (OR = 0.38; 95% CI, 0.35-0.41; OR = 0.41; 95% CI, 0.4-0.43). Further, compared with non-Hispanic patients, Hispanic patients were also less likely to have a diagnosis of CD (OR = 0.34; 95% CI, 0.32-0.36; OR = 0.33; 95% CI, 0.32-0.34) and UC (OR = 0.5; 95% CI, 0.47-0.53; OR = 0.45; 95% CI, 0.44-0.46).
“CD and UC are modestly less prevalent among patients of non-white races and Hispanic ethnicity in the U.S. We believe that these findings should provide an improved foundation for multiple future research studies, including an improved foundation to inform recruitment targets to evaluate the generalizability of published research and to provide context for studies or resource use,” Barnes concluded. “Future efforts should focus on placing [these] data into appropriate context in the evaluation of disparities in new studies and improving health equity among all patients with CD and UC.”
Perspective
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Disparities exist related to many aspects of IBD including patient populations at risk, age at presentation, phenotypes (eg, perianal disease) amongst different ethnic groups, access to care, response to therapies, unanticipated emergency department visits and hospitalizations. From the epidemiologic and etiopathogenesis aspects, disparities can be useful — when well-defined — to examine potential genetic and environmental factors (eg,diet and microbiome) contributing to the incidence, prevalence and phenotypes.
Other disparities are more relevant to therapeutic options and outcomes. Hence, we can continue to use disparities to study both causation and to improve treatment in diverse populations.
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Barnes E, et al. Abstract 251. Presented at: Digestive Disease Week; May 21-23, 2021 (virtual meeting).
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